Public health is the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society. People like me, who work with the sector, have a duty to champion policies that achieve those ends. That is why countering racism should be a public health issue.
The link between racism and poor health is now being recognised at the highest levels. Toronto’s Board of Health has declared anti-black racism a public health crisis and directed the city’s chief public health doctor to find ways to combat its impact.
I first wrote about racism as a public health issue in the British Medical Journal in 2003, in an editorial that is now regarded as a landmark paper. Since then, more than 500 peer-reviewed papers have documented the profound impact of perceived racism on health. It is linked to higher rates of hypertension and diabetes and lower cancer survival rates. It has also been linked to a persistent premature mortality risk in African Americans double that in the white population.
Perceived discrimination triples the risk of psychosis and doubles the risk of depression. And UK research finds that perceived racial injustices can increase the risk of the same chronic health problems among people from Bame communities even if they have not been victims of racism themselves.
Stress, fear and a sense of powerlessness are bad for you. They can take years off lives. Potentially, then, acts that reduce stress, improve fairness and show that communities can be effective and exercise control over their environments boost public health.
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In 2018 the Canadian Public Health Agency acknowledged racism was a public health issue. There was also significant work on the subject carried out by the National Institutes of Health in the US, under the administration of former president Barack Obama. While this has changed somewhat under the presidency of Donald Trump there is still recognition in the US that racism and health are interrelated.
Yet this has not translated into action. The aim of my 2003 editorial was to ask how we move from documenting racism to developing antiracism as a legitimate focus of medical activity on the public health and prevention front. We have not done as much as we could to move that agenda forward. It is no surprise to me that communities want to take a lead — and I support the Black Lives Matter protests.
Some have criticised the movement for mass gatherings that raise the risk of coronavirus spread. In a pandemic, there is an argument to be had about balancing risks. There are well-defined problems with public gatherings. A utilitarian considers how the risks of infection can be mitigated, by social distancing, wearing face masks, or holding online demonstrations or smaller, socially distanced gatherings that disrupt key services.
But there is also the opportunity cost of not seizing the chance we have now. The BLM movement has caught a moment in time. Agitating for a culture change could ultimately save lives — and fulfil a need for community catharsis over the death of George Floyd, one of the disproportionate number of black people who have died at the hands of the US police.
There needs to be more fundamental change than simply equity in policing. The health threats to black populations are linked to socio-economic disparities fuelled by more widespread racism: inequalities in housing, schooling, children taken into care, employment opportunities, income and social status. Fixing the police response will only have a profound impact on these injustices if it leads to a reset in race relations.
From the vantage point of public health, countries need policies that minimise racial discrimination so that there is equity in opportunity and longevity for all. I hope that this will be the lasting legacy of the BLM movement.
The writer, chief executive of the Wellesley Institute, is a professor of psychiatry at the University of Toronto
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